Terson syndrome

originally was defined by the occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage. Terson syndrome now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressures. Intraocular hemorrhage includes the development of subretinal, retinal, preretinal, subhyaloidal, or vitreal blood. The classic presentation is in the subhyaloidal space.
Etiology:
Terson syndrome has been described most commonly in subarachnoid hemorrhages due to ruptured cerebral aneurysms.Other reports include such causes as strangulation, trauma, hypertension, tumor, and perioperative and postoperative intracranial bleeding. Iatrogenic events resulting in rapidly increased intracranial pressure have also been reported.
Presentation:
The neurologic symptoms are related to intracranial bleeding. Reported visual acuities range from 20/20 to light perception, but they often are difficult to obtain secondary to the impaired neurologic status of the patient.The degree of visual loss is related to the degree and extent of the intraocular hemorrhage.
The intraocular hemorrhage is often bilateral and superficial to the retina. Intraretinal or subretinal hemorrhages have been reported but are less frequent.Preretinal hemorrhage can develop into vitreous hemorrhage weeks after the initial inciting event.The intraocular hemorrhage may be difficult to diagnose immediately because the ophthalmologist may be restricted from dilating the patient for neurologic monitoring. A decreased red reflex can be helpful in evaluating a patient who is comatose, and B-scan ultrasonography can further establish the extent of vitreous hemorrhage in lieu of a dilated funduscopic examination.